Events (in Shanghai) that affect my life (and others')

Living Cost in Shanghai – Medicine

SSC asked more about the living cost. Let me try to answer these “new” questions.

– What about medical expenses, like insurance, hospital visit, drug prices, and even “red packets”?

For medical expenses, it is really hard to give a guideline. It depends on what kind of illness you got. Also, for the insurance, it depends on how much you want to cover… Let me just give some examples, so people have a sense.

A typical hospital visit costs at least 100 RMB. If you just feel not good and want to go to see a doctor, no matter you just feel a little bit fever, or your teeth feel pain, or stomach does not feel good, you need to prepare some money. It works this way:

1. You need to pay the Registry Fee (挂号费). I don’t know how I should translate this into English. It is the fee you have to pay first at the counter to get a ticket. Without the ticket, no doctor will talk with you. Sometimes I just pay the 8 RMB (sometimes 13 RMB) to say hi to a doctor. :-) Just kidding.

2. The Laboratory Test Fee. Recently, doctors in most hotel I go to ask me to do the laboratory test before they give me any suggestion. Blood test and other test is typically 100 – 200 RMB.

3. Medicine Fee. Since recent hospital reform have put the revenue of medicine sell into the hospital’s P&L, and some even connect the doctor’s revenue of sales of medicine with the doctor’s bonus, most doctors are willing to give you more medicine than you actually need. I am often confused about the different types of medicine they gave me. Last time, I got a little bit fever, they give me several boxes of expensive medicines, and many others. I believe although the doctor was hurry to sell more medicine, he still care my health a little bit, so he told me: just eat this (the cheapest one). If you feel good, ignore the rest. If you don’t feel good, then you can try others. It seems he gave me enough backup drug that I even don’t need to take.

Well. For this part, it costs 100 – 200 RMB.

I don’t have any experience to end up within 100 RMB for whatever ill I got in the last three years. Most of the time, if I don’t go to hospital, two tablet of normal fever medicine works great for me.

OK. This is about the medicine and hospital part. As you can see, I am not a professional and I don’t have the ability to tell exactly whether it is the right medicine or not. I just feel I am over charged every time. Medicine is such a special good, that people seldom negotiate with doctors. The root cause is, the sale of medicine now happens in a hospital, instead of in drug store.

Insurance

Most citizens in Shanghai enjoy basic medical insurance. I didn’t really argue with the doctors because although it was expensive, it came directly from my medical insurance account, and I don’t have to pay.

Employees pays a certain amount of social medical insurance from their salary at certain percent, and the employer pays the other part (majority). If I remember it correctly, employers pay 8% of the monthly salary and employee pays 2% of salary. After that, basic medical care is covered.

Besides social medical insurance, you can also buy commercial medical insurance. This really depends how much you want to cover, and it varies greatly from company to company, from contract to contract, and even varies for different age.

Just an example, I know a major disease medical insurance costs 2000 – 3000 RMB per year…

Red Bag

I don’t know exactly the situation of red bag, since I never encountered any serious health problem that requires a red bag. I heard it is not as popular as before. Many hospital hang big banner to claim they don’t tolerate receiving red bag for their doctors. I don’t know the real situation now.

How Expensive It is?

For most people with a job in Shanghai, it is OK to be sick, since the medical insurance covers most of normal disease. However, if there is serious disease (those may cause death), you have to use commerical insurance to cover.

Many people who don’t have that kind of insurance face serious challenge, and to raise money from family and friends, or people in the same company is typical solution.

For foreigners, or expats in Shanghai, i don’t know exactly that the sitution is. If someone has any experience, please feel free to share.

16 thoughts on “Living Cost in Shanghai – Medicine”

Here is an article from the wall street journal about the hospital business. It is frankly, quite depressing. Sorry if I paste the entire article but you need to be a paying member to view it on the wsj.com website.

Costly Cure

In China, Preventive Medicine

Pits Doctor Against System

Hospitals See Threat

To Profit, Bonuses;

Dr. Hu’s House Call

By ANDREW BROWNE

January 16, 2007; Page A1

LOUDI, China — Dr. Hu Weimin has attracted a wide following among the poor in this city by providing free advice on how to avoid high blood pressure and dispensing cheap drugs to treat the condition, one of the biggest killers in China.

His efforts have won him national recognition, and he counsels thousands of patients via the Internet. But Dr. Hu’s public health message has turned him into an outcast at his hospital. Fellow physicians shun him, and administrators bar him from the wards.

o The Background: Dr. Hu risked his career to open a clinic offering free advice — and cheap drugs — to fight high blood pressure.

o What’s Next: The government, which has made medical reform a top priority, faces resistance from hospitals that will see profits cut.

The bottom line: Dr. Hu is bad for business at the Loudi Central Hospital. By making treatment widely affordable and talking up prevention, Dr. Hu says he has cost the hospital a small fortune in lost profits.

Like hospitals all over China, Loudi Central earns the bulk of its income from sales of drugs and high-tech testing. Doctors who pull in the most revenue earn the biggest bonuses. That gives them an incentive to pad the bills, not slim them down. Academic studies show that 50% of all Chinese health-care spending is for drugs. In the U.S., the figure stands at about 10%. “Every prescription is a money-making opportunity,” says Dr. Hu.

Dr. Hu’s experiences show the contradictions that make it difficult for Chinese leaders to fix the country’s broken health-care system. President Hu Jintao has made medical reform an urgent priority. But incentives within China’s pay-as-you go system lead some hospitals to fight changes that almost everyone else agrees are desperately needed. That helps explain why Dr. Hu, a rare whistle-blower, has been lauded in the state-owned national media for preaching basic preventive medicine — but has been treated as a dissident in his own hometown, beaten up by one of his bosses and banished from the hospital wards.

“As a grass-roots doctor in a local hospital, it is amazing that Dr. Hu is trying his best to educate hundreds or even thousands of patients,” says Wu Yangfeng, a professor of the School of Public Health at Peking University and former head of Epidemiology and Cardiovascular Institute at Fu Wai Hospital.

[Hu Weimin]

China’s socialist government once nursed the health of almost everybody. Then, starting in the early 1980s, it launched a privatization program that reversed course. Private spending accounted for 64% of all health-care expenditure in China in 2004, compared with 55% in the U.S. and 14% in Britain. But in China, almost all private spending is out-of-pocket: Private insurance coverage is negligible.

Exorbitant charges are putting health care beyond the reach of millions of people in a country where two-thirds of the 1.3 billion-strong population have no health insurance and must pay cash up front for treatment. If they can’t come up with the often-large sums, hospitals simply refuse to treat them.

Failing System

Popular outrage is growing at the inequities of a hospital system where those with money have a chance to live and those without simply “wait to die” at home. A Chinese health ministry study showed that 43% of hospitalized patients in 2003 discharged themselves against medical advice, two-thirds of them because they had run out of money.

Chinese officials openly concede the system is failing. Just this week, health minister Gao Qiang was quoted by state news agency Xinhua calling for “a hospital management system which stresses public service instead of commercial profit.” His chief spokesman Mao Qunan says, “Hospital reform is the biggest problem we face. The actions of some doctors and hospitals are hard to understand.” He won’t comment directly on Dr. Hu’s case, but expresses general sympathy with him.

The system is failing just as China faces a health challenge of immense proportions. Cancers and vascular diseases leading to strokes and heart attacks have risen enough to replace contagious diseases as the leading causes of death in China. That’s partly because of more sedentary habits and growing numbers of smokers, both linked to an increasingly urbanized and Westernized lifestyle.

Growing Resentment

Resentment over health care is increasing. In November, some 2,000 people mobbed a hospital in southwest China after a boy died there. The boy was rushed in by his grandfather after swallowing pesticides, according to a report by the Hong Kong-based Information Center for Human Rights and Democracy. Doctors sent the old man away to fetch more cash, according to the report, but by the time he returned, the boy — 3 or 4 years old — was dead. There are conflicting accounts about what treatment the boy received. But angry crowds were convinced that doctors let him die while they waited for money. They smashed hospital windows and equipment and clashed with police. At least 10 people were injured.

[China]

Beijing health officials say they are reluctant to pump more government money into health care until they fix the system. They are trying to expand rural health insurance, introduce further caps on drug prices, and add a network of community health centers in cities — but face enormous resistance to changes from some hospitals and the local officials who back them. The central government sees Dr. Hu’s saga as a symbol of the need for the hard-to-accomplish overhaul.

Dr. Hu’s problems started in 1997 in Loudi, a city of 1.2 million a short drive from the birthplace of Mao Zedong in inland Hunan province. An internist at the hospital, he asked permission to set up a clinic to offer education on high blood pressure.

Dr. Hu is driven by personal tragedy. For several decades, his father lived as an invalid following a heart attack. As a boy, he became aware of the hazards of high blood pressure after a brain hemorrhage felled his primary-school teacher.

The hospital wouldn’t free up a room for his venture, but grudgingly agreed to let him use a dank space outside — the coal shed. There, he set up a wooden desk and hung a white sheet, he says, to hide the piles of dirty coal he’d shoveled to one side. His health messages to the crowds that thronged there were simple and cost-free — stop smoking, exercise more, avoid greasy foods, go easy on the salt. For two years, his clinic attracted constant traffic. “Then came trouble,” he says.

As more people picked up tips, Dr. Hu says attitudes in the hospital turned frosty as fellow physicians noticed their own patient numbers falling, and hospital accountants saw decreased revenues. Government data shows Hunan province is a hot-spot for hypertension, brought on by the region’s famously spicy cuisine laden with salt and pork fat. “I kept people out of the hospital,” Dr. Hu says.

Hospital authorities and city officials declined repeated requests for interviews to respond to Dr. Hu’s allegations.

Financial Incentives

A bonus system for doctors is widespread in China, as documented in a study by researchers at China’s Shandong Medical University and the Harvard School of Public Health. Dr. Hu describes in detail how the financial incentives work in Loudi Central, a sparkling new facility.

Doctors who prescribe a CAT scan collect a personal bonus of 20 yuan ($2.50), he says. Inducements grow quickly with the sophistication of the treatment. The bonus for laser surgery: 500 yuan ($63). For a heart pacemaker the reward is as much as 20,000 yuan ($2,500). In addition, he says, the hospital pays departments collective bonuses based on the value of drugs their doctors prescribe. For expensive Western drugs, it’s 3% of the sales price; for cheaper Chinese drugs, it’s 5%.

The extra cash makes a huge difference to a hospital doctor in a small provincial city like Loudi, who typically earns less than $200 a month in salary. Bonuses can be many times basic pay.

Few countries let doctors profit so directly from their patients. China’s system virtually forces the profit-making incentive upon hospitals that are still mostly owned by the government — yet are largely self-funded.

[chart]

In an effort to make treatment affordable, health authorities set low wages for doctors and impose caps on hospital charges for basic care and common drugs, which are delivered at below cost. To make up for this, hospitals and clinics are permitted to charge a 15% to 20% markup on new drugs, advanced tests and technologies. An unintended consequence: Hospitals have turned into giant pharmacies. Some 60% of their revenue comes from drug sales, according to official data.

By the time a drug arrives at a hospital pharmacy in some parts of China it could have passed through as many as three or four distributors, each taking as much as a 15% markup, says Robert Pollard, director of Synovate Healthcare China, a medical consulting firm.

Doctors massively over-prescribe drugs to increase their salaries, numerous studies show. One survey cited in a World Bank study last year showed that less than 1% of drug prescriptions at village clinics in poor areas of China were considered “reasonable” by doctors who reviewed the records.

Similar incentives are undermining China’s public health system. A study in the New England Journal of Medicine found that better control of hypertension could have prevented 11% of all deaths in a representative population of men and women over 40 tracked for a decade. It chided government prevention efforts as “unacceptably low.”

Dr. Hu’s battles with his hospital have upended the personal life of the gentle-mannered 43-year-old, who relaxes by playing violin and practicing tai chi. Matters came to a head when he got into an argument with the deputy director of internal medicine, Chen Binhua, in 1999. According to local court records, the row turned violent: There was some pushing and shoving and then Dr. Chen lashed out with a kick that caught Dr. Hu in the groin. The blow was serious enough to put Dr. Hu in hospital — and, he says, it rendered him impotent. As a result, Dr. Hu says, his wife abandoned him. Dr. Chen, who has retired, could not be reached.

Series of Humiliations

Over the next few years Dr. Hu had to endure a series of humiliations. The plastic sign advertising his clinic was repeatedly ripped down and smashed. In 2003, the hospital director tried to remove him from medical practice altogether and push him into a new job in the hospital union. Dr. Hu refused to go, but he was barred from working as an internist in the hospital wards, meaning he could only do outpatient work. “I was sidelined,” he says.

Finally, in 2004, he resigned and with nothing more to lose took his story to the national media. Investigative pieces detailing his persecution started appearing in prominent state-run newspapers. China Central Television included Dr. Hu in a top-10 list of social campaigners in 2005. Amid all the publicity, the hospital director was removed from his post, with no reason given by the local government.

Dr. Hu withdrew his resignation after two weeks. He says what changed his mind was a petition signed by 3,000 of his patients denouncing the hospital and begging him to stay. “My patients kept me going,” he says.

Since then, he has continued his campaign. On one of his recent Sunday morning rounds, he dropped in on Wu Lianhua, 77, in her windowless basement. A frail grandmother with wispy white hair who gulps oxygen from a rusty cylinder by her bed, Ms. Wu said she ran through 50,000 yuan ($6,300) in three months in another hospital. That exhausted the life savings of the retired textile factory worker and her husband. She borrowed more from relatives and friends. Then, she said, she found the by-then famous Dr. Hu.

Dr. Hu says he immediately took her off a cocktail of expensive imported drugs that he says were working against each other. A Chinese-made generic drug for hypertension plus another for anxiety recently gave her a full night’s sleep for the first time in six months. His monthly bill: just 300 yuan ($38).

‘A Doctor With a Conscience’

“He’s a doctor with a conscience,” says Ms. Wu. Her husband, Li Fuhua, marvels that Dr. Hu refuses bribes. “I offer him eggs, but he won’t take them. He won’t even take an apple,” Mr. Li says.

These days, Dr. Hu’s clinic has moved inside the hospital. The sign now above his door proclaims, in English, “Prevention and Cure Office for Blood Vessel of Heart and Brain.” It’s standing-room-only on weekday mornings as hypertension sufferers, many of them elderly retirees, swarm in to listen to his practical advice. “The most expensive medicine is not always the best,” he lectures the crowd. “Find a drug that works for you.”

Dr Hu’s relations with Loudi Central remain frosty. Even though he’s now part of a national project collecting data on hypertension, his hospital won’t let him back into the wards. With his Web site, he manages some 7,000 patients and runs a high-blood-pressure support group with 50,000 members, though hackers often break through.

Dr. Hu isn’t optimistic about prospects for change in Loudi. Local officials, he’s concluded, “don’t have the health of their people at heart.”

For foreigners who cannot speak Putong Hua are unlikely to received the consultation as mentioned by JS in a public hospital. Some local hospitals has a special department for foreigner. You will get the same treat except the doctors speaks English. For that you’re registration fee is RMB500 before you start talking to them :)

Private hospital is really expensive! And you have to have a bit of knowledge your your sickness and why you have to be warded. A colleague of mine was slapped with a bill almost USD20,000 for warded for 2 weeks. No operation or whatsoever, just lab test, daily checking and of course “hotel” stay for 2 weeks.

Medical services are very commercialize in Shanghai. You can see hospital adverstisement everywhere like subway TV, billboard, magazine, and etc. Unlike some countries, medical is consider as a industry and profession that provides services to public. Therefore, it has to be neutral whereby all hospitals shall have the same goal which is treat patient and safe lives.

I read before an articles claiming that Shanghai medical fees rank the 3rd highest in the world :) Not sure how true is that…

SSC, don’t worry. Thanks for bring new topics to me, which many others readers may like to read.

Yes. DC describes exactly what is happening in Shanghai. Private hospital has emerged so quickly that it has the trend to dominate outdoors media. They work on some “nice-to-have” medical care (like beauty, medical check), and some special directions, like (man/women disease, and some really hard to fight diseases). I don’t know too much about hospital for foreigner. Anyone want to share the experience?

In China – space rockets to the moon, investments for “help” to the dictatorship countries in Africa for future Chinese natural reserves gains, “fast trains” for the rich, all chinese should have a car (only true reason – to show off, don’t mind the pollution !), all this is OK.

But China’s people still suffer so much… WHY ?

My chinese wife’s aunt recently died of lung cancer (she never smoked a cigarette, so think of other reasons, pollution, dangerous work, ?).

Reason : NO money for treatment when needed :-(

They told me too late that she was so ill, so I couldn’t help in time, even I told them to HURRY to the hospital, I would pay ! All people went with her to a Changsha hospital for a cure, but too late…

Her own children didn’t want to help to pay for the treatment when she felt seriously ill, because they had more important things to spent their money on (cell phones, cars, apartments, own children’s needs, etc.)

So, as you see, many foreigners are quite well aware of the situation in China.

In China – space rockets to the moon, investments for “help” to the dictatorship countries in Africa for future Chinese natural reserves gains, “fast trains” for the rich, all chinese should have a car (only true reason – to show off, don’t mind the pollution !), all this is OK.

But China’s people still suffer so much… WHY ?

My chinese wife’s aunt recently died of lung cancer (she never smoked a cigarette, so think of other reasons, pollution, dangerous work, ?).

Reason : NO money for treatment when needed :-(

They told me too late that she was so ill, so I couldn’t help in time, even I told them to HURRY to the hospital, I would pay ! All people went with her to a Changsha hospital for a cure, but too late…

Her own children didn’t want to help to pay for the treatment when she felt seriously ill, because they had more important things to spent their money on (cell phones, cars, apartments, own children’s needs, etc.)

So, as you see, many foreigners are quite well aware of the situation in China.

I’m very sorry to hear about what happened to your wife’s aunt. And I agree, those who can’t pay is being denied of the chance to see a doctor.

After some unpleasant experences visiting doctors in Shanghai, I wouldn’t want to go anymore unless I had some acute illess that I couldn’t wait to go back to the States. I’ve been to both the VIP ward where mostly foreigners go to as well as the regular one locals go to at Dongfang Hospital in Lujiazui, Pudong. I did both just to compare the difference.

2) Not much a difference with the doctors you see you save time. A nurse at the VIP ward took me to the doctor, who’s housed in the regular ward. I didn’t need to wait in line, so time was saved. While with a local’s registration, one has to wait outside the doctors’ offices for a long time.

3) I was prescribed with 3-4 medicines beside the antibiotics given via an IV for three days. It appeared that some of the medicines were not necessary. I stopped taking them after one day. I had to pay another 100 Yuan each time to receive IV given in the VIP ward, which was quite clean and had only one other patient there. My total bill was something like 400 Yuan in total the first time and two hundred something the next two days.

Some clinics seeing expats charge like the doctors would charge in the States. 4 years ago when I first moved to SH I heard about World Link. One day I went into one of its clinics by Hotel Portman Ritz Carlton. I wanted to pick up a brochure listing what services it provided and what doctors they had. Surprisingly, the receiptionist woudln’t give out this informaiton. Meantime, I saw the fees posted in a billborad on the wall. I was shocked to see the consultation fee was something like 1,300 Yuan. Maybe they figure folks going there have overseas insurance coverages, so why not charging them an arm and leg. Although I had excellent medical insurance that pays 90%, I wouldn’t want to go to World Link because I don’t like to reward those who rip people off. Luckly, I was very healthy and rarely needed to see doctors in Shanghai.

A friend of mine had gull bladder stones and was in great pain when she visited Beijing. She went to a hospital . To enroll in the hospital, they took her credit card as a guarantee. She was kept there 3 days without the necessary surgery. They kept giving her injections of pain killer. She spoke with a Beijing friend who told her to change a hospital. But it would not release her inspite of her persistence. Her friend was an influential businessman who had to come and fight with this hospital and finally they released her. The bill came to over 7,000 USD for her stay. She was rushed to the second hospital and had a surgery that night. She had to give “red packet” money(10,000 Yuan for 4 of them) to all doctors who operated on her there. The story afterwards is long, but I won’t get into it.

Bottom line, have a good check up before leaving your country. Bring some medicines for common sickness(sore throat, cold etc) or discomfort to minimize having to go to the doctors.

[quote]For foreigners who cannot speak Putong Hua are unlikely to received the consultation as mentioned by JS in a public hospital. Some local hospitals has a special department for foreigner. You will get the same treat except the doctors speaks English. For that you’re registration fee is RMB500 before you start talking to them :)[/quote]

Not sure where the amount of 500rmb came from. in Shanghai, the Foreigner care clinic where English language service is provided at HuaShan Hospital, HuaDong Hospital and the XuHui & Chang Ning District Hospitals are all under 200rmb for registration. Of course after that, there are lab fees and speciaist fees that would be added regardless of whether youa re local or expat, BUT the foreigner clinic charges more b/c of teh VIP treatment in terms of not having to wait in many of teh regular lines for these tests and scans etc. When I got hit by a car last year, my I was given priority to get my xrays and ultrasound scans done…skipped right past teh line into a leather sofa waiting room for VIP’s.

Total cost of three doctor consultations, scans and xray, and pain meds for the broken rib cost me less that USD$150. 1100rmb for what one xray would have cost me back in the US. Of course I COULD have gone to one of the expat hospitals, but why spend $1100 when ¥1100rmb would suffice.

But, for my wife, I do not want her to even buy a bicycle to ride, because that increase her risk by 500% to get injured. And she doesn’t have the same insurance as me.

If we want to buy an insurance for my wife, then they only cover VERY little of the fee.

We decided not to do that, but then she must be out of the most risky parts of daily life, like bicycles and motorcycles, because they don’t have the same protection in the traffic of China.

Sorry to say, but in one or two years we have to leave China, when I finish my company’s project to teach up-coming chinese manufactureres to make good parts for the ship making industry (which may kill a few european present suppliers !!!!) I’m surely not happy about this… Guys out there, please tell me if it is wise for me to stay to help chinese, or am I just a dumb fool who kills the labour of europeans countries ?? I’m in doubt now.

carsten, looks like we have something in common, I started my career with overseas container services, and if you are from Denmark and engaging in ship building industry, you must be one of the A.P. Moller guy.

To stay in China or not, you have to ask if the Chinese are treating you as one of their own, or if you have sentimental feeling towards this country.

Any foreigner who comes to China without medical insurance is mad. A mate of mine was driven into a truck in one of those wonderful white taxis and the taxi company basically washed their hands of him. His medical bills for a series of botched operations were London prices. How’s four hundred pounds a night to stay in a Shanghai hospital for starters?

Complete rip off. The only way is if you know a doctor personally, and this really means “if your wife’s family has a good doctor contact”. If not, check the evacuation clause on your expat medical insurance. Ring the company up. At the slightest need of hospitalisation you should be on a plane to Bangkok or Singapore where the treatment is better and cheaper. Best hope your company uses SOS International, who are the best for China. My insurer does. Phew. They have access to PLA planes if necessary, as well as military hospitals. Good if you get sick in the middle of nowhere.

In 1992 a friend of mine was evacuated to Hong Kong from the absolute middle of nowhere and it cost 70k US. Impressive eh? 35k of that was a special medical flight in an air ambulance with a doctor and nurse flown in from Beijing to join the patient.

I use a London insurance broker and she gets me the best deals for global expat medical insurance. I won’t post her name or the firm I’m with because this is not an advert.

Premiums went up 20% this year. Ouch.

I suppose you’ve notice WorldLink are getting sued for negligence? Can’t say I’m that interested in going to see “expat” doctors who charge London prices in China. The trick is getting a doctor who actually cares not one that’s motivated by Hong Baos.

I read your site with much interest. I live in Switzerland and my son-in-law is married to my daughter.

Now the father of my son-in-law, living in Shanghai, has to have heart surgery (by-pass-operation). We do not know much about the prices of this operation. Can you find out how much such an operation costs and how much they charge you for day care in the hospital after the operation. We do not know anything about the costs therefore we do not know whether we can aford the operation.

Is it possible you find out a) about the costs of operation and day care

@Rita, sorry to hear that your son-in-law’s parent needs to do the surgery. It may cost 30K – 50K RMB. Well, you know this is just a random number – to give you the concept of how much it may cost – I mean just the base line. Always check with the hospital. I think Zhongshan Hospital is very good, go and check with them.